Loan Application

Personal Information

Title *

First Name *

Last Name *

Date of Birth *

Email *

Mobile Number *

NRC *

Address *: Street address and number

City

State/Province

Postcode/Zipcode *

How long have you lived at the above address? *

Employment Information

Present Employer

Job Title

Employee Number

How many years have you been working for your current employer?

Gross Monthly Income

Net Monthly Income

Your Bank Name *

Account Number *

Maximum amount that can be borrowed is 50% of disposable income

Amount to Borrow *

Payment period (months) (1, 2, 3) *

Application Fee

Interest Rate

I give permission to Vitpay to access my personal information and to contact my employer if employment verification is required for the purposes of this loan application. *

I can confirm that the information provided above is, to the best of my knowledge, true and correct. *

Alternatively, if you do not want use the online form, download the form here and submit your response and documents to info@vitpayzambia.com

Download (.docx)